特发性膜性肾病的中医证候分布与病理分期相关性研究

Correlation between TCM syndrome distribution and pathological stage of idiopathic membranous nephropathy

目的:探讨特发性膜性肾病的中医证候分布与病理分期的相关性。方法:回顾性分析349例特发性膜性肾病患者的实验室指标、病理分期、病理参数积分及中医证型分布,应用统计学方法分析各证型与实验室指标、病理分期及病理参数积分等方面的关系。结果:脾肾气虚、脾肾阳虚、肝肾阴虚、气阴两虚四种证型中,以脾肾气虚居多,随着证型的改变,病理损伤逐渐加重。脾肾气虚证病理分期最低,肾脏病理损伤最轻,而气阴两虚证最重(P<0.05)。结论:特发性膜性肾病病理性质多属本虚标实:本虚初期以脾肾气虚为主,后期以气阴两虚为主;标实以血瘀为主,同时兼有水湿、湿热、湿浊。其病机演变规律多为脾肾气虚-脾肾阳虚-肝肾阴虚-气阴两虚,并且随着证型的演变,其病理分期逐渐加重。

Objective:To explore the correlation between TCM syndrome distribution and pathological stage of idiopathic membranous nephropathy(IMN).Methods:The laboratory index,pathological stage,pathological parameter score and TCM syndrome distribution of 349 patients with IMN were analyzed retrospectively.The relationship between each syndrome type and laboratory index,pathological stage and pathological parameter score was analyzed by statistical method.Results:There were four syndrome types such as spleen and kidney Qi(气)deficiency,spleen and kidney Yang(阳)deficiency,liver and kidney Yin deficiency(阴虚)and Qiyin deficiency.The main syndrome type was spleen and kidney Qi deficiency type.With the change of syndrome types,the pathological damage was gradually aggravated.The pathological stage of spleen kidney Qi deficiency syndrome was the lowest,the renal pathological injury was the lightest,and the Qiyin deficiency syndrome was the heaviest(P<0.05).Conclusion:The pathological nature of IMN mostly belongs to original deficiency and superficial excess.In the initial stage of deficiency,the spleen and kidney Qi deficiency is the main,and in the later stage,the Qiyin deficiency is the main.The syndrome is mainly blood stasis,with water dampness,damp heat and dampness turbidity at the same time.The pathogenesis evolution law is mostly spleen and kidney Qi deficiency-spleen and kidney Yang deficiency-liver and kidney Yin deficiency-Qiyin deficiency,and its pathological stage is gradually aggravated with the evolution of syndrome types.